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Is there a role for enhanced recovery after laparoscopic bariatric surgery? Preliminary results from a specialist obesity treatment center

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Title: Is there a role for enhanced recovery after laparoscopic bariatric surgery? Preliminary results from a specialist obesity treatment center
Authors: Barreca, M
Renzi, C
Tankel, J
Shalhoub, J
Sengupta, N
Item Type: Journal Article
Abstract: BACKGROUND: There has been a relative lack of research on the effect of enhanced recovery in the context of morbid obesity surgery. OBJECTIVES: To determine if the application of enhanced recovery after surgery (ERAS) principles can contribute to reduce postoperative hospital length of stay after bariatric surgery, controlling for other factors that may influence safe discharge on the first postoperative day. SETTING: University teaching hospital, United Kingdom. METHODS: Between February 2011 and December 2014, prospectively collected data on all patients undergoing laparoscopic bariatric surgery under the care of a single surgeon were reviewed. From January 2012, all patients were enrolled in an ERAS protocol and were assessed for fitness for early discharge (within 24 hr from the operation). Baseline patient characteristics and additional concomitant procedures data were compared for patients treated before and after implementation of the ERAS protocol; 30-day readmission data were analyzed for patients discharged on the first postoperative day and those discharged later. The effect of the implementation of the ERAS protocol on discharge on the first postoperative day was analyzed using multivariate analysis, while taking into account the effects of potential confounders (e.g., age, gender, American Society of Anesthesiologists [ASA] grade, concomitant surgical procedures, etc.). RESULTS: Two-hundred and eighty-eight consecutive patients underwent bariatric surgery. Of these, 278 (96.5%) were potentially suitable for early discharge, while 10 (3.5%) patients developed an acute postoperative complication that delayed discharge irrespective of the effect of ERAS. All these patients required a reoperation within 48 hours and therefore were not considered suitable for early discharge and were not included in the statistical analysis. During the entire study period, 100 of 278 (36%) patients were discharged on the first postoperative day, 28.5% after laparoscopic Roux-en-Y gastric bypass (LRYGB) and 60.9% after laparoscopic sleeve gastrectomy (LSG); 178 of 278 (64%) patients were discharged after≥2 days (mean: 2.58, range: 2-5). After implementation of the ERAS protocol in January 2012, the rate of patients discharged on the first postoperative day increased significantly from 1.6% to 39.7% after LRYGB (P<.01). Early discharge increased from 50% to 67.5% after LSG; although this change did not reach statistical significance (P = .294), it nevertheless represents a clinically relevant result. Four (4%) patients were readmitted after having been discharged on the first postoperative day, 10 (5.3%) patients after having been discharged≥2 postoperative days. This difference was not statistically significant (P = .620). CONCLUSIONS: The implementation of an enhanced recovery program after bariatric surgery is feasible, well tolerated, and can significantly reduce the length of hospital stay without increasing readmission rates. Controlling for several possible confounders, implementation of the ERAS protocol remained the strongest predictor of discharge on the first postoperative day after laparoscopic bariatric surgery.
Issue Date: 20-Mar-2015
Date of Acceptance: 15-Mar-2015
URI: http://hdl.handle.net/10044/1/56546
DOI: https://dx.doi.org/10.1016/j.soard.2015.03.008
ISSN: 1878-7533
Publisher: Elsevier
Start Page: 119
End Page: 126
Journal / Book Title: Surgery for Obesity and Related Diseases
Volume: 12
Issue: 1
Copyright Statement: © 2015, Elsevier. Licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International http://creativecommons.org/licenses/by-nc-nd/4.0/
Keywords: Science & Technology
Life Sciences & Biomedicine
Surgery
Enhanced recovery after surgery (ERAS)
Laparoscopic Roux-en-Y gastric bypass (LRYGB)
Laparoscopic sleeve gastrectomy (LSG)
Length of stay (LOS)
RANDOMIZED CONTROLLED-TRIALS
INTENSIVE MEDICAL THERAPY
GASTRIC BYPASS
PERIOPERATIVE CARE
COLORECTAL SURGERY
OUTCOMES
METAANALYSIS
Adult
Aged
Bariatric Surgery
Female
Follow-Up Studies
Hospitals, Teaching
Humans
Laparoscopy
Length of Stay
Male
Middle Aged
Obesity, Morbid
Postoperative Period
Recovery of Function
Retrospective Studies
Time Factors
Young Adult
1103 Clinical Sciences
Publication Status: Published
Appears in Collections:Department of Surgery and Cancer